Where there is a will, there is a way: independent assessment of member state compliance with the pandemic agreement
Authors: Susanna Lehtimaki, Elliot Hannon, Layth Hanbali, Daniela-Filipa Soltan, Kimberley Peek, Tiffany Nassiri-Ansari, Nina Schwalbe
Journal: The Lancet Global Health (2023)

On Oct 16, the world got its first glimpse of the complete draft negotiating text of the proposed pandemic agreement aimed at improving collective pandemic prevention, preparedness, and response.1World Health OrganizationProposal for negotiating text of the WHO Pandemic Agreement.https://apps.who.int/gb/inb/pdf_files/inb7/A_INB7_3-en.pdfDate: Oct 30, 2023Date accessed: November 13, 2023Google Scholar This is a crucial juncture in the 2-year negotiations and for the fate of the agreement as the Intergovernmental Negotiating Body pushes to present the final outcome in May, 2024, at the World Health Assembly.2Hannon E Hanbali L Lehtimaki S Schwalbe N Why we still need a pandemic treaty.Lancet Glob Health. 2022; 10: e1232-e1233Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar From the text, it's clear there remains work to be done. Whether countries can find common ground on building resilient health systems, strengthening surveillance, benefits sharing, and ensuring equitable access to pandemic countermeasures, among many other issues, will go a long way in determining how ambitious the pact ends up being.3Cullinan K Draft pandemic accord: IP waivers and benefits for sharing pathogen information are in—for now.https://healthpolicy-watch.news/draft-pandemic-accord-ip-waivers-and-benefits-for-sharing-pathogen-information-are-in-for-nowDate: Oct 17, 2023Date accessed: October 19, 2023Google Scholar But there is also a notable absence of commitment to an element essential to the agreement's success: an independent accountability mechanism designed to promote compliance with the agreement.4Hanbali L Hannon E Lehtimaki S McNab C Schwalbe N Independent monitoring mechanism for the pandemic accord: accountability for a safer world.https://doi.org/10.37941/RR/2022/1Date: November, 2022Date accessed: October 18, 2023Google Scholar, 5Kavanagh MM Wenham C Massard da Fonseca E et al.Increasing compliance with international pandemic law: international relations and new global health agreements.Lancet. 2023; 402: 1097-1106Summary Full Text Full Text PDF PubMed Google Scholar The pandemic agreement draft contains some positive first steps in improving accountability. These include commitments to states' self-reporting on their pandemic prevention, preparedness, and response efforts and to setting up a global peer review mechanism that aims "to promote and support learning […] best practices, actions, and accountability".6Spark Street AdvisorsUNU-IIGHIndependent monitoring for the pandemic accord: a proposal for action.https://doi.org/10.37941/RR/2023/2Date: Oct 16, 2023Date accessed: October 19, 2023Google Scholar The Conference of the Parties, made up of state delegates that govern the agreement's implementation, has reserved the option to assemble an implementation and compliance committee if it considers such a subsidiary body necessary. The language about the committee, however, needs to be more specific. It leaves too much open to interpretation. History has shown that, including for pandemic preparedness and response, relying solely on state self-reporting and peer review does not work.7Sarkin J The 2020 United Nations human rights treaty body review process: prioritising resources, independence and the domestic state reporting process over rationalising and streamlining treaty bodies.Int J Hum Rights. 2021; 25: 1301-1327Crossref Scopus (5) Google Scholar It is an important step, but cannot alone hold states sufficiently accountable to make a meaningful difference in their treaty compliance. Instead, independent monitoring must be explicitly enshrined in the document itself.8Meier BM Kim YB Human rights accountability through treaty bodies: examining human rights treaty monitoring for water and sanitation.Duke J Comp & Int'l L. 2016; 26: 139-228Google Scholar The current infrastructure to deal with global health emergencies, built upon the International Health Regulations (IHR), does not include this type of explicit provision for empowering an implementation and compliance body.9World Health OrganizationInternational health regulations (2005).third edition. WHO, Geneva2016Google Scholar It relies solely on state self-reporting and voluntary peer reviews of states' progress. With the IHR, there is no real way of independently monitoring whether states are adhering to their commitments to one another. Lessons learned from international treaty monitoring show that states' reporting is often late, incomplete, or inaccurate.7Sarkin J The 2020 United Nations human rights treaty body review process: prioritising resources, independence and the domestic state reporting process over rationalising and streamlining treaty bodies.Int J Hum Rights. 2021; 25: 1301-1327Crossref Scopus (5) Google Scholar The good news is that creating an independent monitoring committee is feasible, viable, and achievable if there is political will to put it in place. Existing treaties, from human rights to the prohibition of chemical weapons, offer a guide for how to go about constructing such a mechanism.6Spark Street AdvisorsUNU-IIGHIndependent monitoring for the pandemic accord: a proposal for action.https://doi.org/10.37941/RR/2023/2Date: Oct 16, 2023Date accessed: October 19, 2023Google Scholar First, any monitoring committee must have a specific and concrete mandate that does not overlap with the mandate of other existing bodies.4Hanbali L Hannon E Lehtimaki S McNab C Schwalbe N Independent monitoring mechanism for the pandemic accord: accountability for a safer world.https://doi.org/10.37941/RR/2022/1Date: November, 2022Date accessed: October 18, 2023Google Scholar In this case, an implementation and compliance committee's mandate would be to verify the timeliness, completeness, and accuracy of reporting, including the authority to call out non-compliance.10International Institute for Global, Health, Spark Street AdvisorsPolicy brief: independent review and investigation mechanisms to prevent future pandemics.http://collections.unu.edu/eserv/UNU:8102/n2021-05-12_PB_Future_Pandemic_Response.pdfDate accessed: October 20, 2023Google Scholar Second, to ensure a committee's technical independence, borrowing from human rights treaty practices,7Sarkin J The 2020 United Nations human rights treaty body review process: prioritising resources, independence and the domestic state reporting process over rationalising and streamlining treaty bodies.Int J Hum Rights. 2021; 25: 1301-1327Crossref Scopus (5) Google Scholar the body would be empowered to seek out alternative sources of information to verify state reports. Such sources could include shadow reports by civil society and global organisations, reports by intergovernmental organisations, and confidential reports. In situations where additional verification is required, the committee would be able to conduct in-country visits and make direct inquiries to states to check the accuracy of state reporting.11Hanbali L Hannon E Lehtimaki S McNab C Schwalbe NR Independent monitoring and the new pandemic agreement.BMJ Glob Health. 2023; 8e013348Crossref Google Scholar To ensure the committee's financial independence, it could use funding from a pooled source such as the Pandemic Fund12The World BankThe pandemic fund.https://www.worldbank.org/en/programs/financial-intermediary-fund-for-pandemic-prevention-preparedness-and-response-ppr-fif/governance-structureDate accessed: October 20, 2023Google Scholar to help shield the committee from powerful donors' influence and their interests. An overall package of structural terms and conditions, ranging from appointment procedures to operational protocols, can help preserve the committee's technical, operational, organisational, political, and financial independence from countries, donors, and other organisations. For example, the terms of the committee's selection process should be based on merit and experience, with individuals serving in their personal capacity (not as a representative of any government) to avoid cronyism.13Office of the UN High Commissioner for Human RightsReporting guidelines: committee on the elimination of discrimination against women.https://www.ohchr.org/en/treaty-bodies/cedaw/reporting-guidelinesDate: July 1, 2022Date accessed: September 1, 2022Google Scholar Creating non-renewable term limits (that encourage expertise while minimising careerism), reasonable work requirements (not too much or too little, both of which can subvert authority), fair decision-making processes, and empowering relevant responses, are all proven ways of actively ensuring independent performance. Enshrining these principles of independence and building on existing treaty monitoring mechanisms provides a baseline starting point for developing a term of reference for what an implementation and compliance committee could and should look like for a pandemic agreement. In other words, there is a clear way forward on codifying compliance and accountability—what is needed now is the will to make it a reality.6Spark Street AdvisorsUNU-IIGHIndependent monitoring for the pandemic accord: a proposal for action.https://doi.org/10.37941/RR/2023/2Date: Oct 16, 2023Date accessed: October 19, 2023Google Scholar We declare no competing interests. Research informing the development of this comment was funded by Vital Strategies. The opinions expressed are solely those of the authors.